Healthcare Lies

Let’s face it: pretty much everything that comes out of D.C. is either “edited” to fit a political narrative or simply an outright lie. Healthcare is no exception. Let’s look at Healthcare Lies.

Obamacare Lies

  • “You can keep your insurance plan if you want to.”
  • “You can keep your doctor if you want to.”
  • “Premium costs per family will go down an average of $2500 per year.”
  • “I will not sign a plan that adds one dime to our deficits,” Obama stated in his 2009 State of the Union address.
  • “Obamacare will not raise a single tax on middle income Americans.”
  • “Obamacare will reduce emergency room visits.”
  • “Obamacare exchanges would increase competition for policy premiums.”

I almost did NOT include the above lies, simply because we’ve heard them over and over. I listed them simply to illustrate my first line above: all those Obamacare lies were either purposeful or simply for “a specific narrative or political expediency.” Regardless, you and I are paying for those lies.

What about the “new” Healthcare proposal? The Graham- Cassidy Plan details are included in my previous post including a link to the actual legislation that will go before the U.S. Senate next week. In the meantime, you can bet the Left — both inside and outside of D.C. — are going nuts, attacking it in every way imaginable and some ways that are simply unimaginable. Even television host Jimmy Kimmel weighed in. When watching this 9 minute clip of his attacks on Senators Cassidy and Graham AND Fox and Friends Brian Kilmeade against whom Kimmel makes personal attacks including name calling, note the claims he makes about the Cassidy-Graham Plan are lies that we will “document” below:

Kimmel’s lies? Graham-Cassidy DOES protect those currently under any pre-existing condition situation going forward. How? Money being spent now by the Federal Government — the same amounts being spent now (which Kimmel lied saying funding would be cut) — in block grants to the state include monies for pre-existing conditions. States will have the prerogative to structure their programs as they wish, even creating “high risk” pools which would include such individuals. Let’s face it: there is no “well” for which to go to for unlimited funds. Obamacare made that claim expecting that the exorbitant costs for many of those with pre-existing conditions would be offset by all the young people who would enroll and pay premiums without using the insurance. When that didn’t happen, the Federal Government (who don’t have any money but get it always from us through taxes, fees, and penalties) said, “No problem. We’ll just pay those claims and let taxpayers eat them.” Imagine having a REAL plan with REAL provisions that will work to cover those stuck in that position.

Kimmel also said that Cassidy lied when he stated every American regardless of physical condition should be able to get insurance coverage and that Cassidy would never vote for any bill that did not state that. Cassidy did NOT say “every American would have insurance.” Think about how ridiculous that is: there are millions of young Americans who are healthy, just getting started as adults, who don’t want health insurance — especially at the prices for premiums under Obamacare. 45% of those who rejected insurance under Obamacare and chose to pay the penalty instead are under the age of 37. They paid $1000 or more to NOT have insurance. Why? BECAUSE THEY DON’T NEED OR WANT IT! Also, if they were suddenly afflicted with something serious, they could simply pay $1000 and be immediately covered under Obamacare — even if they had never paid a dime for any coverage AND were diagnosed with terminal cancer. Obama promised these young Americans would run to the Exchanges the first day of enrollment to signup and begin paying premiums. Didn’t happen. Without those millennials in Obamacare paying premiums, blanket pre-existing coverage does not work financially. Under Graham-Cassidy it would.

Sidenote: does it seem American to you that the government forces Americans to pay for insurance, even if they don’t need it and don’t want it? It is purely socialist for a government to forcibly confiscate money from its citizens who don’t need or want medical services so that the government can pay for others’ medical services — “forcibly” being the operative world. Doesn’t that sound a little like the way Venezuela operates? And it’s working REALLY well for them!

Other Lies about Graham-Cassidy

  • It makes abortion illegal. Graham-Cassidy prevents government funding for abortions other than for the life of the mother, rape, or incest.
  • It terminates health insurance for over 30 million who have insurance under Obamacare. Graham-Cassidy terminates NO insurance policy. What it does is stop forcing Americans who choose to not have insurance (and didn’t have it until Obamacare forced it) to buy insurance. Those on the Left to confuse Americans state that this is “canceling insurance policies” when in fact it allows Americans to make their own health insurance decisions.
  • Graham-Cassidy cuts federal funding for healthcare. Graham-Cassidy actually STOPS government payments to insurance companies and exchanges for health insurance to instead block grant THE SAME AMOUNTS BEING PAID NOW to the states. It is true Graham-Cassidy terminates both the employer and employee mandate, but allows each state to re-instate those mandates at the state level “IF” the state decides to.
  • Graham-Cassidy Healthcare block grants shrink over time, then ends. This is absolutely false. Please go back to the previous day’s blog post that spells out provisions of the structure of the plan and see IN WRITING this claim is absolutely false.
  • “We don’t need a new plan. We have a plan to fix Obamacare ready to go that would be much more effective and inclusive that Graham-Cassidy.” I’ve heard this claim for months now from the Democrat leadership. What do you think about their “fix” plan? Uh…..I can’t find it, even though I’ve looked really hard. You know why? THERE ISN’T ONE!

Summary

Do you know the thing that shocks me the most about the furor in Washington and in all of the media about Graham-Cassidy? NO ONE HAS READ THE BILL. In the midst of their cries and complaints saying “We haven’t even seen the bill and don’t know what’s in it;” “The Republicans are waiting until the last minute to ram it through the Senate and House leaving bi-partisanship possibilities out.” (Imagine “IF” the GOP wanted to do that: kinda’ like the Dems did with Obamacare, right?) Even Sean Hannity today griped on his program that he has not been able to find the bill anywhere. (I sent him an email with a link to my story yesterday just in case he can’t find it tonight)

Folks, this is crazy! If we do not take control of the spending on health insurance now, our economy is doomed to slide into oblivion in a matter of just a few years. Yes, some say American healthcare is not #1 in the World. I disagree. Either they’re wrong or I am. In either case, it is at least in the top five. Why then was it necessary to spend more than $1 trillion more on Obamacare than we spent on our private/government healthcare finance partnership before Obamacare during a corresponding time period? This is crazy! Our healthcare didn’t get better. People who had insurance got poorer coverage at much higher premium costs, then couldn’t use their outlandishly priced policies because they could not afford the deductibles! In the meantime, thousands of doctors and other health professionals headed for the hills, retiring early or just switching professions. Why? BECAUSE THE FEDERAL GOVERNMENT CANNOT GET ANY MARKETPLACE OPERATIONS RIGHT — NEVER HAS AND NEVER WILL!

            “Here Lies Healthcare: R.I.P.”

Bottom Line: Healthcare should be operated and managed primarily by the private sector in conjunction with the federal government for Medicare, Medicaid, VA, CHAMPUS, and the existing other federal programs, just like it so successfully has done for so many years.

Think about this: for all those before Obamacare that wanted insurance but couldn’t afford the premiums, we could have spent less than half the $1 Trillion we spent extra on Obamacare and bought each a commercial insurance policy. And if we had taken that route, we wouldn’t be scrambling to save the entire American Healthcare system today.

We can blame the previous Administration for that. And unless “WE” the People get this one right, American Healthcare as we have known it in our lifetimes is dead.

 

 

 

Graham-Cassidy Healthcare Bill

Why cannot Congress give to the American people the full text of pending legislation before their floor debate and vote?

Lindsey Graham and Bill Cassidy — U.S. Senators from South Carolina and Louisiana — have with several other Senators crafted an interesting replacement for Obamacare. Let’s face it: Obamacare is imploding financially. Short of a trillion dollar U.S. Government bailout, it will die a slow death in the next few months. It does not work, and was purposely designed to fail. Why? Liberals are committed to a Single-Payer Healthcare System. (See my post from several days ago explaining that system) The Senate is planning to roll out the Graham-Cassidy bill in the next few days. Fortunately for you, I have researched the proposed bill and I actually have the bill in its form in which Congress will receive it. First, here’s a simple summary, followed by a section of Frequently Asked Questions, then I’ve attached in .pdf the actual bill to be submitted that’s 140 pages long! To save time, read the first two sections. Then please download the actual piece of legislation.  Don’t get lost in the detail! This may be the most important piece of legislation in Congress during your lifetime.

Summary of the Bill

On September 13, 2017, U.S. Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI) and former U.S. Senator Rick Santorum (R-PA) unveiled legislation to reform health care.

The Graham-Cassidy-Heller-Johnson (GCHJ) proposal repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states to help individuals pay for health care.

This proposal removes the decisions from Washington and gives states significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state. The block grant is run through CHIP and is subject to a mandatory appropriation.

The grant dollars would replace the federal money currently being spent on Medicaid Expansion, Obamacare tax credits, cost-sharing reduction subsidies and the basic health plan dollars.

The proposal gives states the resources and regulatory flexibility to innovate and create healthcare systems that lower premiums and expand coverage.

More specifically, GCHJ:

  • Repeals Obamacare Individual and Employer Mandates.
  • Repeals the Obamacare Medical Device Tax.
  • Strengthens the ability for states to waive Obamacare regulations.
  • Returns power to the states and patients by equalizing the treatment between Medicaid Expansion and Non-expansion States through an equitable block grant distribution.
  • Protects patients with pre-existing medical conditions.

GCHJ also eliminates the inequity of four states receiving 37 percent of Obamacare funds and brings all states to funding parity by 2026. As an example, Pennsylvania has nearly double the population of Massachusetts, but receives 58 percent less Obamacare money than Massachusetts.

Graham-Cassidy-Heller-Johnson treats all Americans the same no matter where they live.

Before you read the actual bill that will be submitted shortly to the full Senate, (and that final bill is attached at the end of this post) read these Frequently Asked Questions with answers.

Frequently Asked Questions

What is It?

  • Federal block grant given annually to states to help individuals pay for healthcare.
  • States would have significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state.
  • The grant is run through CHIP (“Childrens Health Insurance Program”) and subject to a mandatory appropriation.
  • Grant dollars would replace the federal money currently being spent on Medicaid expansion, tax credits, cost-sharing reduction subsidies and the basic health plan dollars.
  • Repeals the individual mandate, employer mandate, and medical device tax.

What are examples of what states can do with the money?

  • Assist individuals to purchase health benefit coverage by premium support.
  • Enter into arrangements with insurers, including managed care providers, to encourage market participation.
  • Pay providers.
  • Help with out-of-pocket costs.
  • Up to 20% of the funds may be used to help the traditional Medicaid population.
  • High risk or reinsurance pools.

Why are we doing this?

  • Obamacare took power away from patients and states and gave it to the federal government. This returns that power to where it belongs.
  • Each individual state is a laboratory of democracy, allowed to innovate to find solutions.
  • Four states get 37% of Obamacare dollars. (California, New York, Massachusetts and Maryland) Support should be equal across the nation.

Do states have a match like they do under Obamacare?

  • No, there is no state match under the block grant.

How is money divided between the states?

  • The starting point is the amount of money the state and state residents receive from Medicaid expansion, ACA tax credits, CSR payments and BHP in 2017. The Medicaid expansion portion of the 2017 figures are brought forward using MACPAC inflators with the rest being grown by CPI-M until 2020, at which point the baseline formula begins.
  • By 2026, at base rate, every state will be receiving the same amount of money for each beneficiary in the 50-138% FPL range. This ensures that high-spending states and low-spending states come to parity at the end of the time frame. In order to ease this transition, the incremental increase in the national amount available is distributed evenly each year. Each year’s US total is calculated by adding 1/6 of the total amount in 2026 to the previous year’s total US amount.
  • Starting in 2021, the total number of eligible beneficiaries between 50 and 138% of Federal Poverty Level (FPL) is calculated for the United States in the previous year. Then, the percent of those in this FPL range that live in each state are calculated for each state. The total amount of federal money for a given year is then multiplied by the state’s percent of beneficiaries to give the state its amount for the year. This amount is recalculated annually to account for changes in population in the FPL range.
  • Also beginning in 2021, a risk adjustment formula begins to phase in to adjust for certain population factors. The risk adjustment formula overlay will be applied in a budget neutral manner and ensure that every state remains within ten percent of the mean per beneficiary amount in 2026.
  • In 2024, the model has an adjustment to account for enrollment in credible coverage, which is defined as having an actuarial value that fulfills the CHIP actuarial value which is approximately 70%.
  • As under the CHIP law, CMS may grant waivers allowing lower AV value.
  • If a state chooses to provide coverage with policies of (AV) less than CHIP, the amount of money the state receives is adjusted for this. This is done by multiplying the amount of money that the state would receive by the ratio of the average AV of what is provided divided by the AV of the CHIP standard.
  • This coverage transition occurs in order to align incentives for states to increase enrollment among their eligible population and is done in a way that provides non-expansion states sufficient time to catch up with expansion states in enrollment.

Why was 50% – 138% FPL selected to share money between states?

  • This percentage range represents the population currently on Medicaid expansion. This population disproportionately struggles to access heath insurance, and is, therefore, a better population to use when assessing need and determining state allotments.
  • This extends below 100% FPL because some states did not expand traditional Medicaid coverage to 100% FPL prior to accepting Medicaid expansion.
  • The goal is to achieve parity in the amount that states receive for each beneficiary within this range by 2026 on a risk adjusted basis.
  • Through regular population assessments, the formula accounts for states that experience dramatic population increase or decrease and for economic factors like recession that may cause more individuals to drop into this FPL category.
  • In 2024, the allocation begins to become progressively dependent on enrollment to incentivize coverage. This ramps up from a factor of 25% in 2024 to 75% by 2026.
  • The different factors of the formula are specifically designed to give states flexibility and account for population shifts and economic downturns.

Are states restructured to using the money on individuals between 50-138% FPL?

  • States may use the money at the individuals in any FPL with the exception that no more than 20% may be used on a state’s traditional Medicaid population.

Is this considered a further expansion of Medicaid?

  • No, Medicaid expansion as currently designed would end. Instead, states can use the money how they want to, as long as it is for health care.

How are shortfalls in funding for some states addressed?

  • States will have several options to address any shortfalls in their funding under the formula. If a state decides that it needs more revenue than it is receiving, it can replace the revenue lost by re-imposing the penalties associated with the employer and individual mandates, which this law repeals on the state’s businesses and residents.
  • Although this law does not require states to put up state match for the Medicaid expansion, states could continue to dedicate the money that they would use for math to augment money received from the federal government.
  • States will have increased flexibility in designing systems to deliver care. This should allow better use of federal dollars, saving states money.
  • For those states that lose money in any year under GCA compared to BCRA grown by CPI-M, they may continue to receive their scheduled DSH dollars that are cut under the ACA, provided they put up the state match rate for funds drawn down. They could not get more DSH dollars back than the amount of money they would have received if 2020 base rate had grown by CPI-M.
  • Should a state experience a shortfall in federal dollars in 2020 because their experience is different than projected, they may draw down funds from their total 2025 and 2026 allotment equal to their shortfall.

What happens to unused funds in the block grant?

  • States may roll over unused funds for up to two years.

FINAL Summary

Read as much of this as you care to weigh into. But under NO condition take the word for the Media pundits explanation of what this plan is or isn’t. Case in point: Jimmy Fallon went nuts on his show blasting this plan telling lies about several parts of it — most notable stating that it does away with coverage for those with pre-existing conditions. That is categorically incorrect.

My final thought for you is simple: if Congress does not pass this law now, we are headed toward the demise of Obamacare very quickly, unless the Feds want to write really big checks totalling around $1 Trillion to bail it out simply to keep it alive a little bit longer. That’s their goal. They want a Single-Payer Healthcare system to replace Obamacare.

Thanks for reading this lengthy post. Feel free to download the actual bill in the .pdf file below titled “LYN17709.”

Thanks!

LYN17709

 

 

Single-Payer Healthcare Part II: How Much Will it Cost?

“If” Congress and the President decide Single-Payer Healthcare is the correct replacement for Obamacare, how much will it cost?

That simple question requires a not-so-simple answer. The correct answer depends on what type of program would be developed and whose numbers you choose to believe. Senator Bernie Sanders calls his proposed plan “Single-Payer,” at the same time labeling it “Medicare for All.” That is a misnomer: Medicare is NOT Single-Payer. The government currently contracts with private commercial insurance companies regionally to process Medicare claims and make payments to medical providers of all types from funds provided by CMS — “Centers for Medicare and Medicaid Services.” His proposal is similar to the modified plan used in Canada described in Part I of this topic.

How much would Senator Sanders’ program cost? Watch this Sanders discussion about Single-Payer healthcare from 1987:

https://youtu.be/NyIWpYDP-PQ

Obviously the Vermont Senator has changed his tune. Does he now believe it is financially viable? And if so, what are his estimates of cost? How would it be paid for? Directly from Senator Sanders, here is the financial structure of his “Medicare for All” plan. (these numbers are all provided by Sanders):

The Plan Would Be Fully Paid For By:

  • A 6.2 percent income-based health care premium paid by employers.
    Revenue raised: $630 billion per year.
  • A 2.2 percent income-based premium paid by households.
    Revenue raised: $210 billion per year.This year, a family of four taking the standard deduction can have income up to $28,800 and not pay this tax under this plan.A family of four making $50,000 a year taking the standard deduction would only pay $466 this year.
  • Progressive income tax rates.
    Revenue raised: $110 billion a year.Under this plan the marginal income tax rate would be:

    • 37 percent on income between $250,000 and $500,000.
    • 43 percent on income between $500,000 and $2 million.
    • 48 percent on income between $2 million and $10 million. (In 2013, only 113,000 households, the top 0.08 percent of taxpayers, had income between $2 million and $10 million.)
    • 52 percent on income above $10 million. (In 2013, only 13,000 households, just 0.01 percent of taxpayers, had income exceeding $10 million.)
  • Taxing capital gains and dividends the same as income from work.
    Revenue raised: $92 billion per year.Warren Buffett, the second wealthiest American in the country, has said that he pays a lower effective tax rate than his secretary. The reason is that he receives most of his income from capital gains and dividends, which are taxed at a much lower rate than income from work. This plan will end the special tax break for capital gains and dividends on household income above $250,000.
  • Limit tax deductions for rich.
    Revenue raised: $15 billion per year. Under Bernie’s plan, households making over $250,000 would no longer be able to save more than 28 cents in taxes from every dollar in tax deductions. This limit would replace more complicated and less effective limits on tax breaks for the rich including the AMT, the personal exemption phase-out and the limit on itemized deductions.
  • The Responsible Estate Tax.
    Revenue raised: $21 billion per year.This provision would tax the estates of the wealthiest 0.3 percent (three-tenths of 1 percent) of Americans who inherit over $3.5 million at progressive rates and close loopholes in the estate tax.
  • Savings from health tax expenditures.
    Revenue raised: $310 billion per year. Several tax breaks that subsidize health care (health-related “tax expenditures”) would become obsolete and disappear under a Single-Payer Healthcare system, saving $310 billion per year.Most importantly, health care provided by employers is compensation that is not subject to payroll taxes or income taxes under current law. This is a significant tax break that would effectively disappear under this plan because all Americans would receive health care through the new Single-Payer program instead of employer-based health care.

This plan has been estimated to cost $1.38 trillion per year.

Let’s put that dollar value in perspective: the United States Government’s budget is approximately $3.8 trillion. That means Senator Sanders’ plan will cost 36.3% of the current U.S. budget total.

Let’s Break it Down

There are certain assumptions made in this and any other Single-Payer Healthcare model:

  1. It is “assumed” numbers are accurate. Obviously, the government financial “experts,” and private consultants who weighed in on the Sanders plan have no history of accuracy in projecting healthcare costs. If any past projections (of Obamacare as an example) are what Americans could expect, that $1.38 trillion would certainly be too low a projection;
  2. It is assumed in this model that current healthcare providers — physicians, facilities, pharmacists, etc. —  will all agree to operate within this plan. In Canada, doctors took massive income cuts when their plan was initiated. Any suggestion otherwise is unfounded;
  3. Taxes, taxes, taxes. Senator Sanders in this plan taxes everybody: employers take a huge hit — 6.2% of grtoss payroll would be paid by employers. Personal income tax rates would climb for all who make $250,000 a year and above: from 37% on the low side to as high as 52%. The controversial “Death Tax” would NOT be eliminated as most feel should, the estate tax amounts would actually increase;
  4. Many tax deductions would disappear for those who make $250,000 or more.

The bottom line to the Sanders Plan is there is NO free ride — except for the poor. And the Middle Class and Upper Class in America would be taxed almost beyond comprehension.

Summary

Let’s be perfectly clear: this plan offered by Senator Bernie Sanders is just one concept of Single-Payer. Any such program will be driven by government payments for all healthcare costs. Remember this: the Government has NO money except what they take from taxpayers. For increased government spending, taxpayers must pay higher taxes.

Washington D.C. currently takes billions of dollars in income taxes from corporations and taxpayers and squanders a huge percent of those dollars. Financial abuse in the Government is rampant. Government financial abuse takes all kinds of shapes. There is an environment in D.C. that fosters such abuses. American taxpayers are viewed by many in government as nothing more than a bunch of piggy banks from which to take money at will. Who thinks there is any structure in Washington that can successfully take-on a new federal program with a estimated cost that equals 36.3% of the current U.S. budget? How many Americans are ready to pay these massive additional income taxes? How many Americans — who have just just single digit approval rates of members of Congress — do you think would trust government to handle such a program? No one at my house is interested in doing so.

In fairness, there are several other types of Single-Payer Healthcare programs in existence. But let’s be clear about one thing: NONE have been as successful as U.S. Healthcare. Healthcare as expensive as it is in the U.S. is still in the very top tier of healthcare in the World. Healthcare is no different than other services we use every day: you get what you pay for.

It was a huge mistake for the Democrats to ram Obamacare down the throats of Americans. It has been a dismal financial failure and has dumbed down American healthcare — and it’s getting worse. Obamacare was clearly the first step toward a Single-Payer system that those on the Left have been clamoring for since the early 90’s. But to quote the 1980’s version of Single-Payer Healthcare as defined by Bernie Sanders, doing so will bankrupt the United States.

Are you ready for that?

 

 

Single-Payer Healthcare: Part I

During the run-up to Obamacare we heard a lot about “Single-payer Healthcare.” With the implementation of Obamacare, such talk slipped into the shadows — but it’s back. Senator Bernie Sanders has started his cries for “Medicare for all,” which was what he called his Single-Payer Healthcare program when he first began to tout it. But it is anything BUT Medicare.

The concept of Single-Payer is amazingly complicated. It is imperative that Americans get familiar with it because what we are hearing from the Left about it is just beginning. Their drumbeat for “Healthcare for all is a right” is just beginning. Those drums will quickly get louder and louder.

What is Single-payer healthcare?

Single-payer healthcare is a healthcare system in which the state, financed by taxes, covers basic healthcare costs for all residents regardless of income, occupation, or health status. The alternatives include “multi-payer” systems in which private individuals or their employers buy health insurance or healthcare services from private or public providers. Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). “Single-payer” describes the mechanism by which healthcare is paid for by a single public authority, not the type of delivery or for whom physicians work. In contrast, multi-payer healthcare uses a mixed public-private system.

Where does Single-payer Healthcare exist today?

Various nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal healthcare, which is implemented in a variety of ways. In some cases doctors are employed, and hospitals are run by the government such as in the UK or Spain. Alternatively, the government may purchase healthcare services from outside organizations, such as the approach taken in Canada.

Canada

Healthcare in Canada is delivered through a publicly funded healthcare system, which is mostly free at the point of use and has most services provided by private entities. The system was established by the provisions of the Canada Health Act of 1984. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual’s health, which remains confidential between a person and his or her physician. Canada’s provincially based Medicare systems are purposefully kept as simple as possible to restrict administrative costs. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private insurance represents a minimal part of the overall system.

In general, costs are paid through funding from income taxes, except in British Columbia, the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes. A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. Virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized.

Cosmetic surgery and some forms of elective surgery are not considered essential care and are not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, as long as premiums are up to date, and there are no lifetime limits or exclusions for pre-existing conditions. Pharmaceutical medications are covered by public funds or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. However, specialists care is NOT covered unless deemed essential.

Canadians do wait for some treatments and diagnostic services. Survey data shows of those needing to see a specialist, 89.5% wait less than three months. Of those waiting for diagnostic services such as MRI and CAT scans, diagnostic tests defined as “non-emergency magnetic resonance imaging (MRI) devices; computed tomography (CT or CAT) scans; and angiographies that use X-rays to examine the inner opening of blood-filled structures such as veins and arteries,” 86.4% wait less than three months. Of those waiting for surgery, 82.2% wait less than three months.

Taiwan

Healthcare in Taiwan is administrated by the Department of Health of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002, Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population, and there were a total of 36 hospitals and 2,601 clinics in the country. Health expenditures constituted 5.8 percent of the GDP in 2001, 64.9% of which coming from public funds.

The current healthcare system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government.

The NHI is touted around the World by single-payer proponents as being the marquee of all such healthcare systems. In a government-run single-payer system like Taiwan’s, technical health care issues like higher premiums are inherently political issues, tied to the political establishment. In a recent report on PBS, politicians have been wary of increasing premiums since 2002 “because everyone is concerned about courting the voters’ favor.” Unfortunately, NHI needs steady revenue to help cover the cost of the benefits it offers, which are comprehensive. In a 2003 Health Affairs article, it was noted that NHI covers “inpatient care, ambulatory care, laboratory tests, diagnostic imaging, prescription and certain over-the-counter (OTC) drugs, dental care (except orthodontics and prosthodontics), traditional Chinese medicine, day care for the mentally ill, limited home health care, and certain preventive medicine (pediatric immunizations, adult health exams including pap smears, prenatal care, and well-child checkups),” and even “expensive treatment for HIV/AIDS and organ transplants.”

The combination of generous benefits and relatively meager contributions from the insured has created a system where there are insufficient resources left for other aspects of  health care outside of coverage. “There’s very little R&D, according to the PBS report on its Sick Around the World special. The budget just isn’t there…There is no technology assessment, or very little, except for drugs, and there’s just slower overall adoption of new technology… There’s very low doctor-to-population [1.5 for every 1,000 people], nurse-to-population ratios [3.6/1,000]. So overall, Taiwanese feel the tightness everywhere.

United Kingdom

Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems. Despite there being separate health services for each country, the performance of the National Health Service (NHS) across the UK can be measured for the purpose of making international comparisons. In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index. It was criticized for its poor accessibility and “an autocratic top-down management culture”. The index has in turn been criticized by academics, however.

Each NHS system uses General Practitioners (GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency departments. Community pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs.

Summary

Single-payer Healthcare is obviously different from country to country. The commonality is that the federal government of each country that has such a healthcare system is the primary source of regulation and funding. Operating rules, regulations, covered services, etc., vary from country to country.

By now you are probably asking, “What’s the price citizens in these countries pay for coverage?” and “What would single-payer cost in the U.S.?” and “What would coverage be in the U.S.?” As promised, in Part II of this we will answer these three questions in detail tomorrow. You probably will be surprised when you look in.

You may want to forward this segment to people you know or simply share on your social media outlets. You can bet the Liberals in the America are going to escalate their push forward to replace Obamacare with single-payer healthcare. Before the arguments begin — and there will be many and they ALL will be loud and ugly — it would be smart to listen to all of those armed with facts.

You’ll get those facts here.

Healthcare: What do we do Now?

I’ve just about had it. Everyone understands that for 7 years Republicans promised with the House, Senate, and White House, they would ALL repeal and replace Obamacare. It hasn’t happened. And it looks like it will NOT happen. So what’s next? (I’ll put in bullet point to keep this brief)

  • If a replacement plan cannot be created and implemented, understand that options are very limited. There are only two: let Obamacare fail which will (without a replacement) throw health insurance back into the private sector — IF insurance companies still want to be a part of it; or keep Obamacare which will cost Americans trillions of MORE dollars and still will not work for any Americans except the low income sector. How so? Even though Liberal love to say that Obamacare helps the poor, it doesn’t.  That’s a boondoggle. Medicaid has been there for the poor for a long time…and it works. Low income Americans that were stuck financially between Medicaid and Commercial insurance now have insurance that others are paying for: subsidies, employer/employee taxes, levies, etc. Those punitive taxes and fees and penalties were and still are all unnecessary IF Congress would look at a common sense method of reforming healthcare finance.
  • The big stickler for the holdout Republicans is primarily that in Obamacare, large Medicaid subsidies have been given to many states to sweeten the taxpayer funded Medicaid at the state level. Of course most people LOVE handouts — especially those who don’t participate in paying for those handouts. In the D.C. atmosphere of “tax and spend,” it is virtually impossible to takeaway gifts once they are given. Those Legislators find themselves in a position of being threatened with their jobs if those state Medicaid block grants that are in place in Obamacare (and that are primarily the reason for the $1 trillion deficit in just two years of the ACA) are taken away. I’m sorry to have to put it this way, but those Legislators are making their political decisions based on political pressure, NOT what is best for Americans.
  • It will be insanity at the highest level if Congress allows the ACA to continue or if any replacement plan they pass does not terminate any of the Obamacare employer/employee fines, penalties, and other mandates and do NOT take control of the runaway Medicaid spending from Washington. THEY MUST NOT LET THE U.S. GOVERNMENT TAKEOVER AMERICAN HEALTHCARE! Why? Give me one example in U.S. history when the federal government has put its finger on the scales of the U.S. economy to pick winners and losers, take a program out of the private sector and nationalized it, or taxed any business into success. I’m waiting……waiting……waiting. It hasn’t happened! Every time the Government has done so that program has been a total failure. Healthcare finance controlled by the Government will be the same thing. Why would those 535 men and women on Capitol Hill not recognize that and even consider trying to do the same thing that has over and over again in history become a colossal failure!
  • Medicare: over and over again Socialist reformers in Congress and on the D.C. fringes keep crying “Medicare for all….Medicare for all!” What they are really crying for is “Free healthcare for all…..Free healthcare for all!” Most Americans don’t understand that Medicare is NOT an entitlement. All working Americans have a percentage of every paycheck withdrawn. Those withdrawn amounts along with a percentage amount equal paid into a Medicare account specifically for that employee. That was structured when Medicare was founded to be a government subsidized medical savings account that would be there for each American when they retire. Great program, right? Only if the money was there. We were told for decades those deposits were in the “Medicare Trust Fund.” The only problem is that Congress for years has annually raided that fund, withdrawn those taxpayer savings, and spent it to pay U.S. Government bills. That’s worked well, hasn’t it? Even stealing OUR money they have us now owing $20 trillion primarily to China! Single payer healthcare — which is what Obamacare was always intended to morph into — in any country in the World is UNSUSTAINABLE and un-affordable. Even Bernie Sanders — America’s greatest Socialist — has acknowledged that single payer is financially not viable. Who pays for it in other countries? Taxes…..taxes….taxes….more taxes.

Opinion: the U.S. Senate will NOT reach consensus on any straight repeal or a repeal and replace healthcare finance bill before Friday. Why? They don’t want to and they don’t have to. After all, what’s at stake for them? They could lose their cushy Congressional jobs if voters turn them out. But they’ll still have those amazing retirement programs that are vested for life. They’ll still be able to trip their salaries and go to work on K Street in Washington, which is where all the lobbying firms are headquartered, and they’ll be revered in their home states until they die as “great, selfless public servants who gave their lives for their fellow citizens.”

I’m afraid the horse is out of the barn. Because of greed and money and the quest for permanent power, the majority of members of Congress don’t care who controls the House, Senate, or White House. They all have verbally or quietly committed to perpetuate the Ponzi scheme of Washington: perpetuate power and income through legislation, while always turning away any legislation which might be good for Americans, but might turn off the gravy spicket for members of Congress.

If you think I’m wrong, I respect your right for that. But just because you think I’m wrong doesn’t mean I am wrong. Several days ago I released and exhaustively researched skeleton plan to YOU that if put in the hands of honest federal legislators who are really seeking a comprehensive and affordable way to give back to most Americans their healthcare plans the Dems took away with Obamacare, we could expect to see that or something similar put in place. THEY DON’T CARE BECAUSE WE DON’T CARE ENOUGH TO MAKE THEM CARE. The old healthcare finance program had issues, but those issues could have been solved with a plan that provided better access for those with existing conditions and those stuck financially between Medicaid and commercial insurance.

Why did the Democrats blow it up and put us where we are? POWER! With power in Washington, Government can control every phase of your life. Healthcare finance is just the start.

Big Brother showed up around 1984. He still live in Washington, and he’s got your number!

“From each according to his abilities, to each according to his needs”  Karl Marx

This from Karl Marx — the father of pure Socialism and Totalitarianism. Read it. I’d like any Socialist to reply to this post and explain to me who will be the one(s) to decide what the abilities of people are and who will decide who has needs that they cannot meet and how much of others should they receive.

The ONLY Fix for Healthcare That Will Work: Part 2

In Part 1 of this Analysis, we discussed the specific and integral parts of Healthcare Finance so all could understand the elements critical to making it work.  Let’s detail the “Fix” so we can get started:

Fee Schedule

  1. Medicare Part B has an existing fee schedule as does Medicaid. To “fix” healthcare finance, Congress needs to pass a law (enforced and administered through the CMS) requiring ALL insurance companies who wish to remain part of the Medicare Part B Reimbursement system to adopt a private insurance fee schedule that will parallel the Medicare Part B fee schedule long in existence, and agree to NOT balance bill policy holders for any amounts charged above the fee schedule amounts. (See the “Fee Schedule” detail section of Part 1 of this posted yesterday)
  2. Healthcare Providers will also agree to accept fee schedule payments from ALL insurance companies — Medicare, Medicaid, active and retired military and military family dependent payers, AND private insurance companies — as payment in full for their services and will not balance bill patients for amounts billed which are above the fee schedule allowable amounts.  (See “Fee Schedule” detail section of Part 1 of this posted yesterday)
  3. Hospitals which now are paid primarily under a Medicare Part A plan fee schedule (which is drastically different than Part B and we will not get into today) will be included in the CMS fee schedule requirement to continue to operate in the Medicare system. (Again see “Fee Schedule” detail section of Part 1 of this posted yesterday)
  4. Most out-patient providers are already involved in the Part B fee schedule system for government payers. They will also be required to adopt the private insurance fee schedule for payment for their services rendered under ALL payer policies.
  5. Drug companies will be required to enroll in a separate but similar fee schedule system created and administered by CMS as part of the same law passed by Congress.

Will Hospitals, Physicians, out-patient Providers, and Drug companies agree to these requirements?

Of course in the free market system a business typically has the right to set its own operating rules and guidelines, particularly as they pertain to pricing for their goods and services. However, Healthcare is a different and unique beast. There are currently existing issues from time to time with timely and accurate payment by the private insurance companies who are contracted with the Federal and State governments to be claim processors and claim payers for government insured individuals and also for their private insured policy holders. These primarily pertain to timely payment for provided services, accurate payment for provided services, and claim denials and the subsequent appeals process for providers. For this process to work, Congress and CMS would have to assure providers and require insurance companies that payments for ALL provider services will be paid within no more than 45 calendar days of receipt from providers by the insurance companies of accurate and complete coded bills and applicable medical treatment documentation sufficient to adjudicate the validity of each claim. Further, for denied claims, the appeals process for providers must be streamlined so as to resolve claim disputes with providers that provides resolution within 15 days of receipt of secondary data, documents, and/or information by the payer from the provider for each denial sufficient to determine treatment necessity.

Hospitals will balk and fight prolifically to stop implementation of such a system. Why? $$$$$ The billions they make now will be reduced initially. However, market forces of supply and demand in the competitive business environment will over a short time significantly reduce their costs of operations which will offset most of their initial revenue decrease. However, when a business has for years because of NO competition been able to price their goods and services at any prices they choose, they have been able to pile up profits with no regard for their “customers.” Unfairness and greed now drive the healthcare pricing model. Competition with open and public information about services will take care of that. The same holds true for Drug companies. Insured people will actually be able to check prices and know in advance what costs will be.

Guaranteed payment for medical services within these specific times will be mandatory for providers and insurance companies to agree to this system. Insurance companies currently operating as Medicare and Medicaid claims processors, payers, and administrators are handsomely compensated for their services under government contracts. But they all fight government red tape. The payment process to providers must immediately move up to #2 in the Healthcare Reimbursement pecking order barely behind the healthcare provided to patients. Healthcare professionals and institutions are required to obtain initial and continual significant education and certification in their respective fields. The costs to them for this are staggering as are costs for treating patients. Fair and timely compensation MUST be a priority.

Healthcare Lobbying

In today’s healthcare system, special interest groups continually drive the cost of medical services steadily upward. Those special interest groups are comprised of multiple non profits, lobbying firms and individuals, politicians, and attorneys — all who have built-in objectives for pushing for and against regulations in healthcare, healthcare provider issues, patient issues, facility issues, and even federal and state legal issues. Hospitals have lobbyists that lobby Congress for assistance.  Patients have lobbying entities that operate on their behalf like AARP and others that market their services for a price to their “members” — American citizens — who trust these and others to lobby Congress for their specific desires in healthcare. The AARP is one example of hundreds of lobbying entities whose lobbyists “get” face-time with government officials to “sell” their products, ideas, and concepts. Lobbying of Lawmakers and others on Capitol Hill for any and all issues concerning Healthcare Finance must immediately be terminated by law. The massive flow of lobbying dollars that go to influence lawmakers to make decisions on healthcare finance must be shut off. They alone have driven the costs of healthcare to astronomical levels over the last two decades.

Healthcare Tort Reform

This too must be immediately tackled as part of Healthcare Finance reform. We all see and hear the constant 60-second commercials by attorneys, “phishing” for clients as part of  “pending” Class Action lawsuits against pharmaceutical companies for complications attorneys claim occur from certain drugs. The same holds true for purported problems with certain medical devices and treatments. The common denominator of these is Litigation. Certainly there are times when litigation for some of these is justified and the responsible entities should be held accountable for harm to patients. But “phishing for clients” on radio, television, the internet, and print media, while occasionally will help a injured person who has no idea what to do, most often simply creates massive malpractice insurance premiums for healthcare providers of all kinds who are punished — not for their misdeeds, but for the greed of attorneys. Many of those attorneys often are not as deeply concerned as it may appear for the injured persons they are trying to reach in those ads. Often they will file suits with no plan to litigate and take a provider or insurance company to trial. They know the cost of litigating a case is high. They will offer to settle, knowing that those they sue understand the costs and will pay up front rather than finance a trial — even when those providers and/or insurance companies know they are right.

How do we fix Tort Reform? By a law, (that does not impact the injured) that sets damages that can be collected from such a lawsuit at “actual damages” with no “punitive damages” paid above “actual.” In fact, some states already have those laws in place. This will pay those injured fairly, but will only pay attorneys legitimate amounts for their services. This in itself will stop much of the senseless and often unethical litigation that has driven the cost of healthcare dramatically higher. And in most of these cases, the attorneys are the only winners, eating up huge percentages of settlement amounts instead of those injured.

What do we do about Medicaid funding?

Simple: for medical treatment providers must accept Medicaid fee schedule payments from insurance companies. But the overall funding of Medicaid must go back to the strict combination of Federal and State funding through block grants. States need to be responsible for their Medicaid patient treatments and provider payments. What needs to change immediately is “Means Testing” for Medicaid coverage. The current system for eligibility is broken. Example: a man and a woman live together but never marry. They have children. Because they are not married, even though he works as does she, if she applies for Medicaid they are immediately covered because eligibility is computed using solely her income but NOT his. The process must be revised based on REAL financial needs rather than social obligation (which is promoted by Democrat Party social politics). If someone truly needs coverage because of income and obligations, it will be provided.

What About Pre-existing Conditions?

The cost for treatment of those in this category will dramatically drop with the institution of the fee schedule system. However, a fund exclusively for this coverage must be created to begin coverage at implementation of this system. Because there is no way to accurately predict what those costs will be, this fund will have to be flexible. One suggestion for the source of funding is to use the billions of dollars collected by the federal government as fines and settlements from corporations and other entities for various violations of regulations and laws. Examples of this are the billions of dollars banks have paid for improprieties in mortgages and breaking other banking laws, chemical companies for environment regulation violations and others that most often under the Obama Administration have been paid to partisan non profit organizations as partisan campaign seeding and “payback” for political support. (This would be another way to “follow the money” in political campaign contributions)

Summary

Without this or a similar Healthcare financial overhaul that protects actual healthcare and providers, America will soon be a socialist third-world country — at least in Healthcare. Americans do not deserve that. But any such overhaul will not happen without the stopping of people and entities with their hands in the pockets of Uncle Sam.  They are taking Americans’ dollars for corporate, personal, and political purposes that are earmarked for the health and welfare of American citizens. The greatest healthcare system in the World does NOT need to be blown up. Healthcare finance does, using the skeleton of the government/private funding system that is already in place and has worked with dramatic and positive results for decades.

Who can get this done? That’s the big question. The answer? Only Americans who activate themselves and others to educate friends, relatives, business associates, and political representatives to the concept, then push to get it done. There MUST be demands for legislators to immediately instigate the legislation mentioned above (and any other necessary) to stop the lobbying in Healthcare while initiating the laws necessary to structure compliance obligations from facilities, providers, and insurance companies to operate in this scenario. Tort reform goes hand in hand with lobbying termination. It CAN be done. But it will NOT just happen.

Please forward yesterday’s Part 1 and today’s Part 2 of this: “The Only Fix for Healthcare that WILL Work.”

 

 

The ONLY Fix for Healthcare that will Work

This is Part 1 of a two-part explanation of the Only Fix for Healthcare that will Work. Part 2 will be up at 1:45AM Central tomorrow (if you’re an early riser, later for you if you sleep in!)

The moniker for the BIG noise in D.C. is “Healthcare.” All the noise is not really about “Healthcare” — it’s about Healthcare Finance. NO ONE is talking about it, and it’s the only thing that matters. American Healthcare is the BEST in the World! And what is happening in Washington now threatens that. How? Money drives everything that ever shows up in the Marketplace. And that includes Healthcare, which reportedly gobbles up 16-18% of our entire Gross Domestic Product. Mess around with the dollars in Healthcare and it will absolutely impact the quality we receive. What needs to be addressed is how the dollars are handled in Healthcare, and how they “should” be handled. Let’s do that.

Where do Healthcare dollars go? Hospitals, physicians, clinics, ambulance and other medical transportation providers, surgery centers, imaging centers, other outpatient treatment centers, pharmacies, Drug Companies, medical devices, and last but not least: insurance companies. Let’s look at each.

  1. Hospitals are the biggest dollar consumers: they set prices for procedures of all kinds, infrastructure costs (room charges, supplies and drugs used in hospitals, charges for equipment and miscellaneous expenses, etc.). They pretty much have a monopoly on what they charge consumers. Americans cannot shop for the best hospital prices: there are no window stickers to use to negotiate. Think about it: have you ever called and priced a heart procedure for the purpose of getting the best price? How about foot or brain surgery? No. When we check out, we get a bill that is priced as the hospital wants to price it. Hospitals in America make billions of dollars in profits, even those institutions who are technically not-for-profit entities. Profit is derived simply by computing revenue left after paying actual expenses. So to make billions, these hospitals charge far more than actual costs.) 
  2. Second in the dollar consumer list are Physicians. Once again Americans cannot “doctor shop” easily to get the best deal for doctor care. Most often they are chosen by referrals from OTHER doctors, and usually for special reasons. And their pricing is usually directed by hospitals in which their patients receive care and/or insurance company contracts.
  3. Other providers find themselves typically in different pricing models than Hospitals or Doctors. Their pricing — with few exceptions — are determined by insurance companies through “fee schedules” or “policy exclusion or allowable rates.” Example: you’ve been hit by a car on a busy street. Can you call around to get the best price for that emergency ambulance transport that you need to save your life? Nope. And that ambulance that takes you to the closest trauma center will bill your insurance company some “rack rate” for the transport. But most policies have limits for certain procedures or the insurance companies will simply pay what they think is fair. The same holds true for most other types of providers.
  4. The 900-lb gorillas in the Healthcare Finance room are Insurance Companies. They are all two-part profit centers for their stockholders, members, and/or owners. How? Premiums + Investments. They charge policy holders premiums for coverage for health procedures. Premium pricing basis is a closely held secret and is handled pretty much like medical procedure pricing by Hospitals and Doctors. However, they are loosely based on mathematical probability factors assigned by internal personnel that assess the probability of each policy holder’s potential need for services and insurance company liability for treatment costs. Many factors weigh into that pricing: age and physical history of the insured, past and current medical conditions, geographical location, vocation, etc. But there is a significant gap between estimated costs to the insurers and the amount of premiums. The dollars that constitute that gap are invested by the insurance companies in many places: money market funds, stocks, bonds, loans, and others. Make no mistake, insurance companies are profitable. And we should NOT feel that their profits are evil. Insurance company profits are mostly distributed to stockholders, members, owners, re-invested in community programs, that all typically put most of those profits into the American economy. It’s part of the free market system that rules the U.S. economy.
  5. Pharmacy along with Outpatient Providers that typically include transportation, outpatient surgery centers, imaging, dental, and others are almost all covered by fee schedules for payment.  (See “Fee Schedule” below)
  6. Drug Companies is another class of medical provider that consumes a large portion of healthcare revenue. Their justification for high prices is two-fold: research and development and testing new pharmaceutical products is extremely costly, and liability for unexpected effects of the drugs forces high prices to cover possible litigation.

The single objective of the Healthcare System overhaul in the United States should be this only: to bring down the costs of all medical care — including health insurance premiums — provide medical insurance coverage to the maximum number of Americans as possible, all with absolutely no negative impact on the quality of American Healthcare.

So how do we do that?  Let’s dive in.

Work Backwards

In most business systems in the private sector, profit is the driving force behind business operational structure. Profit in Healthcare is critical and necessary for multiple reasons. Healthcare needs to remain primarily in the private sector. Very few government health systems are effective or successful today. The American Healthcare System driven by the private sector worked well before the American version of Government Healthcare: Obamacare. Achieving the objectives above CAN be accomplished in the U.S. without a total government takeover, which would destroy what we have in today’s private/government partnership. The Government works well with its responsibilities for Medicare, Medicaid, and the Veterans Health System. There are issues there, but all can be corrected without total Government takeover. Instead of concentrating strictly on dollars, let’s begin by insuring the continuation of the critical piece of the system:  Medical Treatment and work forward to Dollars.

Medical Treatment

It is impossible to discuss treatment without inclusion of Physicians — known for at least a century as critical technicians who (on the most part) garner amazing respect — primarily for the extensive education they must absorb, but also for the life saving procedures and treatment they provide us. Very few physicians prepare to fight for reimbursement for their services when entering the Healthcare System after their education. There is no competition for pricing so there are no limits for pricing with the same exceptions. (See “Fee Schedule” below) Physician reimbursement needs to be adjusted which will allow their concentration on continuation of the very best treatment of patients while developing new procedures, devices, and drugs through research and development. Follow through this process with me and you will see how we can accomplish this.

Medical Facility Treatment and Care

Hospitals house all that is necessary for physicians to do their jobs. The Hospital role is critical and also very costly. For most of their work, they set pricing. And their doing so is totally arbitrary. And because there is none (or very little) competition in the market, there are no limits for their pricing, with several exceptions. (See “Fee Schedule” below)

Insurance Company Pricing

There IS some pricing competition driven by the markets for policy premiums. Insurance companies are forced to compete for business. In addition, most states have Insurance Regulatory offices that have requirements for insurance companies’ pricing and are able to somewhat stabilize premium costs. However, deciding what to pay healthcare providers and facilities for specific services is almost solely determined by insurance companies with several exceptions. (See “Fee Schedule” below)

Outpatient, Medical Transportation, and Pharmacy Prescription Pricing

Pricing for these services are almost totally regulated by fee schedules. (See “Fee Schedule” below)

Drug Company Sales Pricing

This is another of the big consumers of healthcare dollars that goes largely unregulated. U.S. drug companies have pretty much run rough-shod in the marketplace, pricing their products with no limits or restrictions. There is very little competition in the marketplace because of the high costs of research and development and testing required for FDA approval for new products. Drug companies spare no expense to protect their product territory, often using lobbyists in D.C. to impact what little regulation they face in marketing their pharmaceutical products. (See “Lobbying” below)

Fee Schedule

There are approximately 150,000 different treatment codes for medical treatments today. These codes are devised and implemented by the CMS (Centers for Medicare and Medicaid Services) — the government agency charged with administrating U.S. Healthcare law as passed by Congress. Medicare and Medicaid (and some commercial insurance companies) each have a “Fee Schedule” that includes the dollars that are allowed by the government to be paid to providers for any of those approximate 150,000 different treatments “when” the provider prepares and submits an accurate and compliant bill to the specific insurance company CMS contracts with to process those claims. The “Fee Schedule” concept is the critical fix that must be implemented to fully repair our Healthcare finance structure.

Summary

In tomorrow’s offering, we will look closely at exactly how the “Fix” should use and what specific steps we must take to make this thing work. You will be surprised at the few steps that are necessary and how simple it would be to make them happen, IF we did not have the politics to navigate through to get there.

I hope after tomorrow you will be engaged in this “Fix” process so deeply you will share this plan with all you know — including specifically the lawmakers who represent you along with your friends, family members, and acquaintances. If Congress simply lets Obamacare fail or if they band aid a fix together that is nothing but “Obamacare Light,” American healthcare is doomed to fail. Maybe not us but our children and grandchildren will then be forced into a Central American-like healthcare system that will be drastically changed for the worse from American Healthcare of 8 years ago.

Healthcare Lunacy California Style

We are hearing the term “single payer” pretty often in the connotation of healthcare funding.  What you may not have heard is that California has a bill pending to turn the entire state into a single payer entity with the government of California paying for ALL healthcare for EVERYONE — including illegal immigrants!  The projected cost for California:  $400 Billion per year.  Yes, I know, that is an astronomical figure for spending for an astronomical venture.

How do they plan to pay for it?  It’s actually a pretty simple plan — more taxes, broken down this way:

$200 Billion will be paid with a 15% payroll tax increase;  the other $200 Billion will be drawn from existing local, state, and federal funds.

Needless to say it is very controversial in California as well.  But not controversial like you think.  The state Senate last week passed the bill that now has to go to their House for debate and approval.  But there’s a holdup there.  House Speaker Anthony Rendon killed the bill for this

Bernie Sanders

year even though it sailed through the Senate.  Renton did not mince words:  In a statement, he mentions how the bill “was sent to the Assembly woefully incomplete,” namely that “it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters to make SB 562 a genuine piece of legislation.”  Subsequently Renton has gone into hiding amid constant verbal attacks and demonstrations at his home and office and has received multiple death threats.  Those who are raking him over the coals do not all live in California.  That famous Socialist from the northeast Bernie Sanders has even weighed in.  Bernie Sanders said he was “extremely disappointed” at the Speaker’s action, and prophesied that, “If the great state of California has the courage to take on the greed of the insurance companies and the drug companies, the rest of the country will follow.”

The bill that passed the California Senate, you see, did not address the rather significant detail of how single-payer would be financed. Since the official legislative estimate is that it would boost state health-care costs by $200 billion — which would more than double the state budget — that’s a pretty big omission.  Doubling the state budget and not having a plan to tackle that?  Yes, even though I love much of the state California and have good friends that live there, this proves that old statement that California “is the land of fruits and nuts.”  And most of them work in Sacramento.

Let’s run some quick numbers:

  • Healthcare spending for 2016 in the state was $367 Billion of which the government paid 71%, or $261 Billion  (this according to the UCLA Center for Health Policy Research in their “Health Policy Brief” of August 2016)
  • 2017 year spending numbers are not released yet (for obvious reasons) but are reportedly running much higher than those 2016 numbers

  • Healthcare spending numbers included do NOT include unpaid hospital bills.  Remember:  it is illegal for a hospital to turn away any ill patient who walks into an emergency room.  They get treated for whatever illness for which they arrive at the ER.  We have no recent numbers for those costs, but in 2011 that number was $41.1 Billion.  Hospitals ate that $41.1 Billion, NOT the California government.

Think about this folks:  California is legitimately considering “planning” on spending 1/2 Trillion dollars a year on paying for the treatment and care for anyone who walks into California regardless of citizenship, legal or illegal status, or nationality.  That is crazy enough as it is.  But consider this:  Governor Jerry Brown in his proposed 2017 budget planned for a $1.6 Billion deficit.  Add that number (if it will be accurate) to their $1.3 Trillion debt that already exists.  Pure lunacy!

This is Scary!

You are probably digesting this the same way I am.  I simply cannot believe that are breathing, educated, and reasonable people alive that can somehow reconcile a plan like this.  Unfortunately there are, and they number in the millions.  A bunch of them number among the 535 members of Congress that actually are the ones that could conceivably put together a bill and pass such a bill that could make a program like this actually exist in YOUR life in America.

The Obamacare goal was its failure.  Why would they want it to fail?  It’s simple — follow this scenario:

  1. The Liberal Left in unison passed the Affordable Care Act into law without one person even reading it.
  2. The drafters of the law knew that it was financially nonviable, would lose billions of dollars, and would quickly have to be replaced.
  3. The replacement would have to take healthcare further down the road.  What was “further down the road?”  Single Payer Healthcare.
  4. Obama and the other members of the Liberal Left knew that once “free anything” was given it could never be taken away.  That would certainly assure no possibility of healthcare finance ever finding its way back into the free market system — the only place it could ever work.
  5. Obamacare is dying a quick death.  Single Payer for the Nation is imminent……except —-
  6. HILLARY LOST THE ELECTION!  That was the ultimate plan:  Hillary, who is a single payer Illuminati proponent, has lusted for single payer healthcare for decades and was handpicked to take American healthcare there as President.

So what do we do now?  I don’t know what we “will” do now, but I know what we “should” do now:  go as far back to free market healthcare as possible.  What would that look like?

  • We keep the few things in Obamacare that are really good:  no pre-existing conditions exclusions, children stay longer on parents policy, Medicaid state block grant funding.
  • Insurance companies market and operate healthcare plans universally — no state boundaries.  That will drive insurance costs down dramatically both in cost of policy premiums and procedures.
  • Healthcare providers ALL participate in an adjusted regional fee schedule for every treatment provided to patients.  Medicare has for decades had a fee schedule for this that works really well.  It is regionally skewed:  an MRI cost paid to a New York hospital is higher than an MRI cost paid to a hospital in Longview, Texas.  Why?  the NY actual expense is much higher.  The Medicare Part B fee schedule would work beautifully if adopted for all healthcare providers for all procedures.  It prevents price gouging, the uncertainty of knowing how much treatments will cost the patient. (have you ever priced shopped for teeth cleaning or a series of shots for your kids?)
  • Medical Providers would have to be paid within 45 days of receipt of the correctly coded and documented bill by the Insurance company.  This is a critical piece.  Doctors and other providers have to fight hard now to get paid by insurance companies in a timely fashion and paid accurately.  A fee schedule with a 45-day payment guarantee would allow them the ability to operate their practices smoothly which means better patient care.  I have owned and operated a Medical Reimbursement Management company for 25 years.  We fight the battles for doctors, clinics, hospitals, surgery centers, radiology centers, etc. to get them paid quickly, accurately, and the maximum amount they should receive per patient policy terms.  It is uncanny how difficult it is for medical providers to get paid.  Most doctors never think about those reimbursement issues while spending their fortunes on their education.  But they all have to fight to get paid their entire careers.  With that gone, healthcare in every area would immediately improve dramatically.
  • I have a doctor in my family who has never been sued but pays $100,000 a year in medical malpractice insurance premiums.  Why?  “Ambulance chaser” lawyers.  We MUST have tort reform immediately.  Doctors screw up and make decisions that negatively impact the lives of patients and their families for life — sometimes they even cost patients their lives.  There needs to be reimbursement to those injured for these incidents.  But the reform needs to be adjusted to be just actual verifiable damages instead of the settlements that read like this:  “$25,000 for actual damages, $2 million for pain and suffering.”  This alone would decrease the cost for providers in the nation that some estimate to be as much as 20%.  The problem is attorneys:  most Congressional legislators ARE attorneys.  They look out for their own.

As far as healthcare in the U.S. is concerned, we need to be careful we do nothing that hurts actual healthcare while repairing healthcare finance — the two are totally separate.  America has the best overall healthcare system on Earth.  It is a scary thing to allow Washington bureaucrats to make life and death decisions for the structure of Healthcare.

Unfortunately I see and hear NOTHING from healthcare finance specialists who the government brings into this conversation to fix healthcare finance.  There are doctors in the mix.  But as a whole doctors are not good at finance.  But doctors and others in healthcare are the last to admit they don’t know about finance and to turn it over to specialists.

The American Healthcare System is teetering on the edge of a cliff.  If it is pushed over that cliff into the Healthcare abyss called “Single Payer,” future generations of Americans will never have access to the quality of care Americans have seen in our lifetimes.

 

20 Million

20 Million:  that’s the number of people currently insured under Obamacare will “lose” their insurance if/when the current House and Senate bills are reconciled and signed into law and put in force — so says the CBO and so says ALL the media, even FOX News.  If you regularly read my blogs you read the other day that this is an outright lie:  20 million people that are now FORCED to purchase Obamacare policies but who do not WANT Obamacare will no longer be forced to purchase and maintain insurance.  There’s a big difference.  And there are some very positive things that will result from taking this action.  (Details of those just ahead….keep reading)

I am certain you know that 6 million of those people since the implementation of Obamacare rather than opt-in and pay outrageous insurance premiums chose to pay the fines (or penalties) for not purchasing under Obamacare.  And they have paid $3 BILLION in fees and penalties!

You didn’t know that?  You mean to tell me that FOX, MSNBC, CNN, NBC, ABC, and CBS haven’t reported that?  The New York Times, Washington Post, LA Times, or Chicago Tribune have not printed that?  Hmm…..I can’t imagine why.  How do you think President Obama found some money to pay the nearly $1 Trillion deficit owed by the Federal Government for Obamacare cost overruns and premium shortages in its first cycle?  He used that $3 Billion as a down payment on the bill.  How did the balance of the bill get paid?  I am not certain yet that it DID get paid, but a huge chunk of it was paid by the Justice Department scandal recently exposed.  That scandal was their diversion of billions of dollars in penalties collected from U.S. and foreign banks and corporations that were charged with massive banking violations and environment fines and penalties levied against major corporations from the Treasury to pay Obamacare shortages.  You didn’t know about that — really?  I thought the previous Administration was “the most transparent Presidential Administration in United States history.”  (quote from then President Obama)

Let’s talk about those 20 million.  Honestly, I have no doubt that a portion of those are young people who are healthy, confident of their futures and continued good health, and prefer to NOT pay for insurance they are confident at this time they would never use.  And then when the premium prices shot up, shot up again, and continue to shoot up, they knew factually they didn’t need it.  So they opted out calculating that paying the penalties were much less expensive than paying premiums for insurance they didn’t need.  (Oh, they also knew that under Obamacare if they suffered a quick and major incident that required healthcare they could purchase Obamacare and be immediately covered with no pre-existing condition exclusions)

The balance of those people would have loved to be a part of the American health insured community, and with a reasonable insurance program with excellent coverage at an affordable price would attract them to opt-in.  So how could that be initiated under the House and Senate “Repeal and Replace” plan?  Here’s how.

I am a true capitalist.  I have watched as in my lifetime capitalism has instigated and maintained the multiple generations of economic and social growth in the U.S. that dwarfs every other society’s accomplishments in those areas.  The free market system has always initiated  and maintained steady and stable growth for the American goods and products that when brought to the market place.  In that environment, those goods and products that are desired and/or necessary to Americans and that are priced to be affordable have always been successful.  From time to time someone brings similar goods or products to the free market place that is either a little better, in more in demand, and/or priced more attractively to American consumers.  When that happens those replace the previous goods and products.  That is the free market system.  It historically has only been impeded when the government steps in and takes any regulatory actions that negatively impact any part of that process.

We all know the federal government is too large, too bureaucratic, and too political to ever successfully inject itself into the free market system.  There are examples galore — including many that were implemented and failed miserably during the Obama Administration — of such attempts by the government to implement, control, and assist private entities.  Examples:  Solyndra hoodwinked Obama and his minions into believing their concept for solar energy was sound and economically feasible.  “We” lent Solyndra $535 million taxpayer dollars.  Solyndra is gone as is our $535 million dollars.

“We” lent Chrysler $10.75 BILLION.  They repaid $7.25 BILLION but still owe more than $2.25 BILLION in dividends and interest.  CitiBank got $2.33 BILLION and still owe $2.28 BILLION of that 6 years later.  GM borrowed $50 BILLION.  They owe Americans $11.4 BILLION plus $694 MILLION in dividends.

Putting it plainly:  Government sucks in commercial business.  So let’s let the free market place work again in Healthcare Insurance!

Blue Cross, Aetna, CIGNA, Pioneer Health, Tenet are all in Healthcare to make money.  How do insurance companies make profits?  Two ways:  1) They sell policies and then pay for medical procedures for those policy holders when necessary.  They pray that after paying for medical procedures they have money left over from their collected premiums — unlike in Obamacare.  And they’ve been really successful;  2) Insurance companies invest a certain percentage of their collected premiums in many different places — much of it in the stock market.  On the whole they have amazing success with their investment products.  Who benefits from those profits?  They have stockholders and members who get paid dividends!  Do you have an IRA or other investment retirement account?  You can bet that your account manager invests a large portion of your money in specific insurance companies or in insurance investment funds.  Why?  Because they are profitable!

So don’t you think those insurance companies will look at those 20 million uninsured Americans (that now do not have to pay that $3 Billion in penalties for not buying Obamacare insurance) as potential customers?  And what happens when those 2o million start buying “affordable” insurance policies?  The cost to those insurance companies for paying claims is amortized over a larger base of people which lowers the costs to the insurance companies that then lower premiums.  In the free market that is called “Supply and Demand.”  There is also more positive cash flow to them from sales increases (historically it has happened) which further increases profits and dividends that are passed along to their stockholders in dividends and investment account increases.

It’s time that not only federal Legislators aggressively schedule interviews, press conferences, and town hall meetings to share these and other truths about the proposed healthcare bills (which are NOT “healthcare bills” but are “health insurance bills”) and aggressively educate Americans to these facts rather than parroting the talking points of the Left:  “20 million will be un-insured,” and “thousands are going to die,” and “children will lose their health insurance,” and “single married mothers and their children will be without healthcare.”

Congress:  find enough intestinal fortitude to face those who preach false doctrine about what you are doing in Congress.  Give them FACTS!  Call them out and demand they instead of pontificating their inaccurate propaganda day after day document their claims with cold hard facts.  And to quote a famous rapper from the movie Who’s your Caddy, “EITHER GO BIG OR GO HOME!”

A Diamond in the Rough

There’s a state park in Arkansas that is very unique — it’s a diamond mine.  The Crater of Diamonds is open to the public for diamond mining.  Visitors can register and explore a 37.5 acre plowed piece of ground famous for diamonds.  And when you find a diamond, it’s yours to keep.  How big and how famous are some of the finds there?  The Strawn-Wagner Diamond holds the title of the most perfect diamond ever certified by the American Gem Society.  The 3.03 carat stone achieved the perfect rating of O/O/O by the American Gem Society when cut.    The Uncle Sam Diamond weighed over 40 carats and was found at Crater of Diamonds in 1924.  It is the largest diamond to ever be found in the United States.  When a diamond is found in the ground, it usually looks something like this:

Some actually look a whole lot worse than this — they look just like plain old rocks.  Even when found by professional diamond miners, the miner has no real idea of what the finished product may be.  They go through the process of finding and mining thousands of “rocks” hoping to find that one that will become when cut and polished the perfect diamond worth tens of thousands of dollars.

This entire post today is to remind Americans that good things most often start off as not-so-good things — at least in the beginning few if any know for certain it will become a really good thing.  Think about that:  when our children were born some of us actually visualized a scenario in which that child becomes the President, a Senator, a professional football player, NBA star, and that list goes on and on.   It’s only years and years of nurturing that will mature that baby into a person who has the possibility of achieving our lofty expectations.

Why doesn’t the political environment in the U.S. parallel the environment we live in at home?  Who decided that the U.S. Government is a god-like entity that exists on its own?  When did the men and women in the Government put off their humanity to become a part of that god-like body of people?  And, by the way, who created that process?

The fact is, it does not exist.  That god-like perfection we call Government with all of its glory and infallibility is a figment of someone’s imagination.  Government is a group of people with ideas they supposedly have received from the OTHER people that asked them to join the Government on their behalf.  And every two years that group of people leave the Government (supposedly) and are replaced by people who join for the same purposes but may have some new and different ideas.  The Government itself is NOT a living, breathing creature.  It is to operate FOR the People, not for itself.

Through the last 2+ centuries of its existence as a nation, the United States People have taken that plain and ugly rock discovered by the Vikings or Columbus and have spoken into existence through its founding “Operating Manual” — the Constitution —  that created the U.S. Government.  The intent was for all generations of Americans to revise and refine the Government to make it better, stronger, more and more representative of the People who actually own and operate it.  On the most part we’ve seen that happen.

Steadily over the last half century Americans have each election cycle ceded more and more of the Government to professional politicians that have made themselves elite.  Originally Congressmen were elected for two year terms to go to D.C. to represent their communities for 2 years, then be replaced by someone else from that community.  Senators originally were appointed by state Governors.  Serving for 6 years allowed them to establish and maintain legislation that best represents their state.  Those Senators talked their Congressional counterparts into changing the way they were brought into D.C.  They wanted to enter the political fray identically as those in the House of Representatives.

Senators and Congressmen and Women discovered they could create many more government programs than their constituents sent them to create:  financial and vocational opportunities for themselves full of benefits.  Those include really nice salaries, expense accounts, full time office and legislative staff paid for by taxpayers, exorbitant travel underwriting, amazing medical and retirement benefits, all of which apply only to legislators.  They could only serve two or six year terms, but as many of those as they wanted.  They can make and change laws at will.  Yet they make laws for all other Americans that in many cases Legislators are exempt from.  When this process of transition began to happen, that shiny, brilliant diamond began to lose its luster.

The once perfect diamond of Capitalism that shined brightly as the example for all the Earth began to slide backward into the likeness of many other countries.  Exceptionalism which has set the Nation apart from its beginning began to slip away.  The most amazing work ethic in the World  began to diminish as Congress began to dole out federal benefits for American citizens under the guise of “helping those who cannot help themselves.”  But it really was and is a way to use money to influence Americans to support those who give them money at each election — in essence buying votes.  Today close to 50 million Americans receive welfare.

Healthcare has become the big ticket item in the U.S. in the last 9-10 years.  Yet all this hoopla is NOT about healthcare, it’s about who’s going to pay for health insurance.  Until recently government healthcare insurance underwriting was limited to Medicare, Medicaid, and insurance for active and retired U.S. Military members.  For a hundred years or so Americans looked at commercial private health insurance as an option for those who wanted and could afford it.  It was not a right.  In the last decade or so, that has changed for many.  Many feel that the American government owes them health insurance and should pay for it.  Enter Obamacare.  And watch that diamond’s brightness blurring.

I could go on and on giving example after example about how our country is slipping backwards into the quagmire of Socialism that seems to be the mantra of the Democrat Party and other leftists.  “Somebody owes me something” is the justification for those demands from many in the public.  The problem is that NO ONE can point me to any country on Earth today or any country in history that was a true Socialist country in which Socialism has worked or is working.  They all implode.  Why?  In Socialism, someone has to pay the bills.  The Government appoints itself to be that payer.  But they have to get money to pay for everything from the People.  Socialists don’t believe in Capitalism — true marketplace economics — that states basically that someone creates and provides a product, if someone likes that product and wants to buy it, he/she pays the provider an agreed to price.  If people don’t like the product, it goes away — it simply fails for lack of want or need.  Socialism on the other hand is propped up and managed by the Government.  The Government taxes its citizens out the wazoo and decides who gets paid what for what products and the price, and it makes no difference if the marketplace wants it.  Government says “Do It,” and everyone must comply.

Obamacare is actually a Socialist program.  Unfortunately for many Americans — almost all Americans in that insurance program — it has been financially devastating.  It’s Socialistic and it will not work.  What’s happening now is a product of giving people something and trying to change it drastically or take it away.  Human beings don’t like that.  Fortunately conservatives are fighting now to replace this socialist program by going back to the previous insurance structure that with some changes will right the ship.  By the way, American healthcare was the greatest on Earth for decades.  It is now barely rated in the Top 20 — that in just the few years of Obamacare.

Shiny, valuable diamonds don’t just happen.  Getting them takes years of cooperation between a lot of people and much hard work.  American Healthcare is teetering on the edge of oblivion.  Healthcare professionals spend hundreds of thousands of dollars and years on their medical education to provide Americans great healthcare.  They are running from the system and their professions because a government run system does not work….for anyone.

Americans, we better recognize how valuable our diamond is and educate and empower those in our Government who have their fingers on the choices that can and must be made to protect that diamond.  Its brilliance is evaporating quickly.  I for one don’t want if I ever need heart surgery a government appointed surgeon in my chest who is there just because he told someone he could do the job.  I want the guy/girl in my chest that does 200 of the a year.  And those folks are leaving by the thousands.

It might be good for you to email/call your Congressional representatives and let them know socialized medicine will not be acceptable.  Obamacare has to go.  Listen to your constituents….you work for them.